In the medical field of muscular and myofacial pain, Dr. Janet Travell is recognized as the leading pioneer. She began her work in the 1940s, in the United States. She developed an entire branch of medicine, known as “Myofacial Therapy”. She was President John F. Kennedy's personal physician, and successfully treated his chronic back condition. Myofacial trigger point therapy is based almost entirely on Dr. Travell's work, and is the most effective modality used today by clinicians and therapists who treat muscular and myofacial dysfunction and pain. It is a therapeutic technique that involves the systematic application of pressure to tender muscles and myofacial tissue in order to relieve pain and dysfunction.
Myofacial tissue (also called “fascia”) wraps around muscle tissue, muscle fibers, bundles of fibers, and the muscles themselves. It then continues on to form tendons and ligaments. Thus, fascia and muscle tissues are interwoven. When muscles and fascia are in their normal, relaxed state, the layers of facial tissue, muscle fibers, bundles of fibers, and the muscles themselves all glide alongside one another. When muscular dysfunction is present, muscles contract (cramp) to varying degrees, which is known as “going into spasm”. Moreover, facial dysfunction always arises from muscular dysfunction.
Ordinary muscle cramps and contractions release with movement, that is, stretching of the affected musculature. When the muscle is locked into a deep and painful spasm, it forms a “trigger point.” (Another term commonly used instead of trigger point is “contraction knot.”) Trigger points do not release with movement (stretching). Instead, they are locked into a strong state of contraction. This contraction is essentially a localized hardening of the muscle tissue and associated fascia.
Once the muscle and fascia tissues harden, they become “frozen” in that state. The fascia also forms adhesions, which further restrict the muscle from moving due to a “shrinking” (constriction) effect. Stretching these hardened tissues usually results in a deeper spasm, as the muscle and fascia attempt to protect themselves from what they perceive as further injury. Thus, trigger points require specialized treatment, known as trigger point therapy, to return to their normal, relaxed states.
When a muscle spasms, it sends a message to the nervous system, which in turn causes an even greater contraction, which causes more pain, and so forth. Muscles work in opposing pairs, so when one muscle spasms, the opposing muscle will often spasm in response. Thus, a singular muscle spasm (trigger point) can send a chain reaction of spasm that affects several parts of the body.
The network of nerves in the body passes through the muscular system. When a muscle develops a trigger point (goes in spasm), it compresses the nerve, which sends a message of pain to the brain. Since nerves can pass through many muscles, sometimes the pain is felt in a muscle other than the originating site. This phenomenon is known as “referred pain.” Trigger points regularly cause referred pain. One muscle can have more than one trigger point and associated myofacial dysfunction and constriction.
Trigger point therapy is the application of sustained, direct pressure onto a trigger point. It is most beneficial if this pressure can be repeatedly applied, and at different angles. This pressure interrupts the neural signals that cause both the spasm and the pain. It ultimately lengthens the muscle into its normal state, which effectively breaks the spasm-pain-spasm cycle as well as referred pain. It also enables the myofacial tissue to release any constriction, and return to its normal state.
Trigger point therapy is well known and widely used in the medical field on the muscles of the body, for example, the back or shoulder. In the case of TMJ and other head, face, and jaw pain, if trigger point therapy is used, it is almost always used on the muscles located outside of the mouth. However, the trigger points that are responsible for TMJ and other head, face, and jaw pain, are located inside the mouth. Thus, extra oral trigger point therapy is insufficient, inappropriate, and an ineffective means of treatment.
Clinicians rarely, if ever, utilize treatment of trigger points inside the mouth and jaw. The handful of those that do employ intra oral trigger point therapy use their fingers because there are no available tools on the market. Using one's fingers is a limiting factor because of their size (too big) and length (too short), which makes them unsuitable relative to the tasks of inserting and manipulating them within a patient's mouth to release trigger points. Painful and invasive techniques to release intra oral trigger points are the clinical norm, such as needle injection therapy (including but not limited to cortisone, anesthetic, and dry needle), or medication therapy (including but not limited to muscle relaxants, anti-anxiety, anti-depressants, anti-inflammatories, and pain relievers).
There are many tools on the market designed for the treatment of trigger points located on the “outside” of the body. Many of these tools are unusually shaped, for example, like a spider; the tool has a main spherically shaped body and several different curvy and/or arched “legs”. These tools generally cannot fit into a human mouth. If a patient had adequate jaw mobility and could open the jaw very wide, these tools might fit, but the entire tool would have to be inserted, as the “leg” length is rather short with various curvatures. The patient would most likely end up with their jaw lodged open, and might gag. If these tools were made smaller so they could fit comfortably into a human mouth, their shape and size would still prohibit them from being functionally useful to release intra oral muscle spasms, trigger points, and myofacial dysfunction, as they are designed for use on the outer body of a human.
There are also other tools on the market designed for massaging the body, such as tools shaped like dolphins, small rolling pins, or miniature rodents. They are usually quite thick and wide. Again, while a patient might be able to fit one of these into his or her mouth, the dimensions of the tool are inappropriate for proper manipulation and operability to treat intra oral trigger points. The patient would likely also end up with their jaw lodged open as with the above-mentioned tools. There is also a body massage tool shaped like a large question mark, which is designed specifically so one can hook the curved part of the “question mark” over his or her shoulder, and massage the upper back. The ends of this tool could fit into a human's mouth, but the end caps are about the size of large gumballs, which are too large to be used for intra oral trigger points. Additionally, the shape and overall curvature of this tool do not allow for proper manipulation and operability to treat intra oral trigger points. Lastly, it would most likely result in tremendous discomfort to the human on the receiving end of the treatment.
Lastly, if a massage tool is straight, even if it slim in diameter like a writing utensil, the lack of curvature makes it basically impossible to connect with the vast majority of intra oral trigger points. A straight or minimally curved tool would hit approximately less than 10% of intra oral trigger points, muscle spasms, and locations of myofacial dysfunction. One would also have to open his/her jaw very wide to use a straight tool. Many patients with head, face, and jaw pain have restricted jaw mobility and cannot open their jaws more than one or two fingers' width. Additionally, there are many intra oral trigger points located deep within the mouth. Straight tools would touch other portions of the mouth and jaw while making contact with the trigger points, which can range from uncomfortable to painful, can activate the gag reflex, and can possibly damage delicate tissues.
Therefore, there is a need for a non-invasive, effective, easy to use, drug free and pain free apparatus and method for the treatment of muscular spasms, trigger points, and myofacial dysfunction located in the soft tissue within the mouth and jaw associated with head, face, and jaw pain, including TMJ. Approximately 15% to 20% of the general population suffers from TMJ alone. The percentage is higher for those suffering from other types of head, face, and jaw pain.